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Free COVID Test Orders to End on March 8
  + stars: | 2024-03-06 | by ( March | At A.M. | ) www.usnews.com   time to read: +2 min
By Robin Foster HealthDay ReporterHealthDayWEDNESDAY, March 6, 2024 (HealthDay News) -- Americans will not be able to order free at-home COVID tests after Friday, U.S. health officials announced Tuesday. Households across the country have been able to order four free rapid antigen tests through COVID.gov. The federal government previously suspended the free rapid test program last May after the public health emergency of the pandemic was officially ended. The CDC recommends that people test if they have any COVID symptoms including a sore throat, a runny nose, loss of smell or taste or a fever. More informationVisit the CDC for more on COVID testing.
Persons: Robin Foster HealthDay, “ ASPR, haven't Organizations: Administration, Strategic Preparedness, U.S . Department of Health, Human Services, CNN, U.S . Food, Drug Administration, CDC Locations: U.S
Dengue Outbreaks on Rise in Brazil as Vaccine Rollout Lags
  + stars: | 2024-03-06 | by ( March | At P.M. | ) www.usnews.com   time to read: +2 min
On Tuesday, Sao Paulo's state department of health declared a state of emergency, estimating 300 cases for every 100,000 inhabitants. "We have six million doses this year and 50 million doses over five years," he said. Dengue is now present in 85% of Brazil's municipalities, Kfouri added, spreading into regions where it was never seen before. In some cases, the disease can cause a more severe hemorrhagic fever, resulting in bleeding that can lead to death. The Health Ministry's latest weekly bulletin cited some 1.3 million "possible cases" of dengue nationwide and 299 confirmed deaths related to the disease this year.
Persons: Renato Kfouri, Kfouri, Sebastian Rocandio, Steven Grattan, Bill Berkrot Organizations: SAO PAULO, Reuters, Sao Paulo, Leandra Locations: Brazil, Sao Paulo's, Brazil's municipalities
Sen. Elizabeth Warren has criticized Corizon successor company YesCare for its opaque corporate structure. Yet Geneva's track record is scant; it only incorporated in November 2021, six months before it got the YesCare contract. AdvertisementOnly one agency with a YesCare contract told BI it was aware of the extent to which YesCare had outsourced its operations. AdvertisementAn October 2022 YesCare bid document, submitted to the Alabama Department of Corrections, says PharmaCorr will dispense all prescription medications for YesCare. AdvertisementThe agreement between Geneva and prison healthcare provider YesCare requires YesCare to pay at least $500,000 a month to Geneva.
Persons: Sen, Elizabeth Warren, Corizon, YesCare, , Dick Durbin, Raphael Prober, Prober's nonanswer, Warren, Christopher M, Lopez, Robert Green, Corizon —, Green, Lori Mayer, Aaron Kaufman, Chris Atkinson, Joel Landau, Tehum, Martin Horn, Alabama Department of Corrections YesCare, Thomas Mailey, Bryan Baker, Isaac Lefkowitz, Perigrove, — Lefkowitz, Lefkowitz, David Gefner, Gefner, Storm Harper, PharmaCorr, Jeff Sholey, Steven Weiss, Atkinson, Sara Tirschwell, Zalman Shapiro, Tirschwell, Michael Farrier, Jeffrey Sholey, Judge Lopez Organizations: Service, Corizon Health, Business, Getty, YesCare Holdings, Justice Department, Tehum Care Services, Geneva Consulting, Genesis Healthcare, BI, Geneva, American Correctional Association, . Maryland Department of Public Safety, Correctional, CHS, PharmaCorr, University of West, of Health, Allure, New York State Department of Health, Public, New York City Department of Correction, Alabama Department of Corrections, Alabama, New York State Department of Corrections, Community Supervision, Doña, Okaloosa, LinkedIn, YesCare, YesCare . Alabama Department of Corrections, Gefner, Court, Western, of, Corizon's, Florida's, Florida's Hillsborough County Sheriff's, Tehum's Locations: Missouri, Houston, Texas, Geneva, Florida, Alabama, New Jersey, YesCare, University of West Florida, Connecticut, Massachusetts, Riker's, Doña Ana County, New Mexico, Okaloosa County , Florida, Wyoming, Maryland, Colorado , Florida, North Carolina, Suffern , New York, YesCare's Alabama, of Missouri, Florida's Hillsborough County
The ramifications of a cyberattack on a critical health care technology company are still being felt across the U.S. nearly two weeks later. Change Healthcare has acknowledged the hack, which reportedly affected billing and care authorization portals. “Our experts are working to address the matter, and we are working closely with law enforcement and leading third-party consultants such as Mandiant and Palo Alto Networks on this attack against Change Healthcare’s systems,” Change Healthcare said. “On Feb. 21, 2024, we discovered a threat actor gained access to one of our Change Healthcare environments,” Change Healthcare said. A spokesperson affiliated with Change Healthcare declined to answer whether a ransom has been paid, according to Wired.
Persons: paychecks, Chuck Schumer, Jesse Ehrenfeld, Rick Pollack, , , Schumer, ” Schumer, Pollack Organizations: Healthcare, Palo Alto Networks, New, American Medical Association, Department of Health, Human Services, American Hospital Association, HHS, AHA, UnitedHealth Group, The Washington Post, Justice Department, Health, Medicare, Medicaid Services, Wired, Change Healthcare Locations: U.S, Palo, New York, Optum
A federal judge on Friday rejected AstraZeneca 's legal challenge to Medicare's new power to negotiate the prices of certain costly prescription drugs with manufacturers. The decision is another win for the Biden administration in a bitter legal fight with the pharmaceutical industry over the constitutionality of those price talks. The opportunity to sell drugs to more than 49 million Medicare and Medicaid beneficiaries is a "powerful incentive" for manufacturers to participate in the price talks with the government, Connolly wrote. The ruling comes a month after a federal judge in Texas tossed a separate lawsuit challenging the price talks. On March 7, Bristol Myers Squibb, Novo Nordisk, Novartis and Johnson & Johnson will present their oral arguments to a federal judge in New Jersey in the same hearing.
Persons: AstraZeneca, Biden, AstraZeneca's, Colm Connolly, Connolly, Johnson Organizations: U.S . Department of Health, Human Services, Washington , D.C, Manufacturers, Supreme, District, AstraZeneca, Chamber of Commerce, Bristol Myers Squibb, Novo Nordisk, Novartis, Johnson, CNBC PRO Locations: Washington ,, Delaware, Texas, Ohio, New Jersey
CNN —Change Healthcare, the health insurance IT giant disrupted for days by a cyberattack, on Friday announced plans for a temporary loan program to get money flowing to health care providers affected by the outage. It’s a stop-gap measure meant to give some financial relief to health care providers, which analysts say are losing millions of dollars per day because of the outage. Some US officials and health care executives told CNN it may be weeks before Change Healthcare returns to normal operations. The temporary loan program will help health care providers with “short-term cash flow needs,” Change Healthcare said in a statement. A unit of healthcare conglomerate UnitedHealth, Change Healthcare processes prescriptions to insurance for tens of thousands of pharmacies nationwide.
Persons: ” Carter Groome Organizations: CNN, Friday, Healthcare, White, Health, Human Services, Senior, American Hospital Association, First Health, Justice Department Locations: Maryland, Michigan
But for the nation’s nursing homes, the effects have yet to fully fade, with staffing shortages and employee burnout still at crisis levels and many facilities struggling to stay afloat, according to a new report published Thursday by federal investigators. The report, by the inspector general’s office at the U.S. Department of Health and Human Services, found that the flawed infection-control procedures that contributed to the 170,000 deaths at nursing homes during the pandemic were still inadequate at many facilities. The inspector general’s report described the staffing problems as “monumental,” noting high levels of burnout, frequent employee turnover and the burdens of constantly training new employees, some of whom fail to show up for their first day of work. For nursing homes, the inability to attract and retain certified nurse aides, dietary services staff and housekeeping workers is tied to federal and state reimbursements that do not cover the full cost of care. Rachel Bryan, a social science analyst with the inspector general’s office, said the report sought to ensure that key lessons from the pandemic were not lost, especially now that the acute sense of urgency has faded.
Persons: Rachel Bryan Organizations: U.S . Department of Health, Human Services, Centers, Medicare, Medicaid Services
Women may see greater health benefits from exercising regularly than men do, according to a recent study. DON'T MISS: Exercise 2-4x more than the HHS recommends to achieve maximum benefit, says new studyResearchers also found that women were able to see greater health benefits with less exercise than their male counterparts. Men who engaged in about five hours of moderate to vigorous exercise each week lowered their chances of dying by 18% in comparison to men who didn't. The reason why women may have stronger benefits from regular exercise than men isn't clear, though it's possible it boils down to differences in anatomy, the study's researchers told CBS News. Exercising regularly is great for heart health in general"I think the big message is physical activity helps to reduce cardiovascular mortality, period," Garg tells CNBC Make It.
Persons: Beteal, wasn't, Nadish, Garg Organizations: American College of Cardiology, HHS, University of Miami Miller School of Medicine, CBS News, Hermann, CNBC, U.S . Department of Health, Human Services Locations: UHealth, Houston
Change Healthcare's systems are down for a fourth straight day after parent company UnitedHealth Group disclosed that a suspected cybersecurity threat actor gained access to part of its information technology network on Wednesday. UnitedHealth, the biggest health-care company in the U.S. by market cap, owns the health-care provider Optum, which merged with Change Healthcare in 2022. Optum services more than 100 million patients in the U.S., according to its website, and Change Healthcare offers solutions for payment and revenue cycle management. ET Saturday, Change Healthcare said the disruption is expected to continue "at least" through the day. The AHA declined to comment on the Change Healthcare cyberattack.
Persons: UnitedHealth, We're, CISA Organizations: UnitedHealth Group, Healthcare, U.S . Securities, Exchange Commission, CNBC, CVS Health, CVS, American Hospital Association, AHA, Department of Health, Human Services, FBI, Infrastructure Security Agency, HHS Locations: U.S
It is only the latest in long list of hacking incidents that have roiled the health care sector in the last few years. Mara FurlichPrescription insurance processing at big university health systems in Indiana and California have also been disrupted, according to internal email correspondence at the health systems reviewed by CNN. In a regulatory filing Thursday, Change Healthcare’s parent firm said “suspected nation-state associated” hackers had breached some of their computer systems. The Change Healthcare spokesperson declined to comment when asked on what information the company based its assessment that foreign government-linked hackers could be responsible. The FBI and CISA did not respond for requests for comment on whether they agreed with Change Healthcare’s assessment on who was responsible for the hack.
Persons: Mara Furlich, Furlich, ” Furlich, Camp Pendleton, Luke Bonczyk, Abi, , , CISA, Max Henderson Organizations: CNN, FDA, Healthcare, Naval Hospital, American Hospital Association, FBI, Infrastructure Security Agency, Department of Health, Human Services, HHS, Optum, Locations: United States, Detroit, Camp Pendleton, Southern California, Indiana, California
As a cluster of measles cases grew in an elementary school in southern Florida, the state’s surgeon general sent a letter to parents that contradicted widespread medical guidance about how to keep the disease from spreading. Doctors and health officials typically recommend that children who are not vaccinated for measles isolate for 21 days after they have been exposed at school. However, the state Department of Health “is deferring to parents or guardians to make decisions about school attendance,” the letter, sent to parents at Manatee Bay Elementary School in Weston, Fla., continued. Dr. Ladapo added that these recommendations might change in the future and stressed that children with measles symptoms should not go to school. As of Friday, there were six confirmed cases at the school, according to Broward County Public Schools.
Persons: Joseph Ladapo, of Health “, Ladapo Organizations: of Health, Manatee Bay Elementary, Broward County Public Schools Locations: Florida, Weston , Fla, Broward
AdvertisementMost Americans worry they won't be able to pay expensive medical bills if they experience an emergency, and it's impacting their economic outlook. Voters also identified prescription drug prices, out-of-pocket medical costs, and The Affordable Care Act as priorities for how they will vote in the 2024 election. Over 70% of Democrats, Republicans, and Independents answered that general healthcare costs are their main financial stressor. AdvertisementTrump has been vocal about his plans to repeal and replace the Affordable Care Act should he win reelection. Still, KFF found that seven in 10 Republican voters don't think Trump has an alternate affordable healthcare plan.
Persons: , Joe Biden, Donald Trump —, Biden, Trump, Roe, Wade, Barack Obama —, KFF, Nikki Haley, Haley Organizations: Service, KFF, Kaiser Family Foundation, Affordable, Republicans, Independents, Medicare, Services, Democratic, US Department of Health, Human Services, Trump, Republican, Biden
And among those that do, less than a third selected any single benefit such as subsidized child care services (11%), child care referrals and consultations (28%); and back up child care (26%), which gives parents access to a daycare center or babysitter when their usual child care arrangements fall through on a given day. Among those, 37% offer access to backup child care, 16% subsidize child care and 10% provide onsite child care. Among respondents who said they were thinking of quitting their jobs, 41% said their compensation was not high enough to cover child care costs, and 30% said they didn’t have adequate child care. An onsite child care center like one from Bright Horizons can provide licensed and trained care providers and well-qualified early education teachers. Other options to ease working parents’ experienceFor many employers, though, an onsite child care center may be tough to swing.
Persons: , Jessica Chang, “ Covid, ” Chang, Mercer, It’s, We’ve, Stephen Kraemer, Kraemer, hadn’t, Carmen Perez, Perez, Seda, Chang Organizations: New, New York CNN, US Department of Labor, US Department of Health, Human Services, Century Foundation, “ Employers, Adecco Group, Bright Locations: New York, United States, California
CNN —Menthol cigarette bans are effective at getting people to quit smoking, new research finds. The pooled results show that about a quarter of menthol smokers quit within a year or two when the substance is banned from cigarettes. Menthol cigarette smoking rates were lower in settings with national bans and highest when there were only local or statewide bans. Even if just a quarter of menthol smokers quit, it could improve the health of thousands of people. Menthol itself isn’t addictive, but menthol cigarettes are more attractive to new smokers, studies show, because the flavoring masks the harsh taste and smell that may put some new smokers off.
Persons: Biden, Dr, Sarah Mills, , Mills, Menthol, ” Mills, We’ve, menthols, Rafael Meza, Sanjay Gupta, Meza, There’s, ” Meza Organizations: CNN, US Food and Drug Administration, Tobacco Research, European Union, Food and Drug Administration, Department of Health, Gillings School of Public Health, US Centers for Disease Control, CDC, Studies, Foreign Relations, CNN Health, Cancer Research Institute Locations: Canada
BELLINGHAM, Wash. (AP) — Evelyn Jefferson walks deep into a forest dotted with the tents of unhoused Lummi Nation tribal members and calls out names. “It took us eight days to bury him because we had to wait in line, because there were so many funerals in front of his,” said Jefferson, crisis outreach supervisor for Lummi Nation. Against the backdrop, tribes such as the Lummi Nation, about 100 miles (161 kilometers) north of Seattle, say the proposed funding — while appreciated — would barely scratch the surface. In September, Lummi Nation declared a state of emergency over fentanyl, adding drug-sniffing dogs and checkpoints, while revoking bail for drug-related charges. But truly thwarting this crisis must go beyond just Lummi Nation working on its own, said Nickolaus Lewis, Lummi councilmember.
Persons: — Evelyn Jefferson, , Jefferson, Anthony Hillaire, Hillaire, We’re, Sen, John Braun, we’re, Jesse Davis, Nickolaus Lewis, Lummi, Jay Inslee, Joe Biden, van, It’s, somebody’s, , ” Jefferson Organizations: Lummi, Alaska Natives, Disease Control, Senate, Republican, Washington State Department of Health, Washington Gov Locations: BELLINGHAM, Wash, Lummi, Jefferson, Washington, U.S, Seattle, Alaska, Bellingham, Bellingham , Jefferson
WASHINGTON (AP) — The Biden administration struggled to properly vet and monitor the homes where they placed a surge of migrant children who arrived at the U.S.-Mexico border in 2021, according to a federal watchdog report released Thursday. In about a third of the cases reviewed by the federal watchdog, the agency did not have legible documentation for the adults on file. The federal watchdog analyzed the case files of more than 300 migrant children from early 2021, months after thousands of children had trekked to the U.S. border seeking asylum. HHS is supposed to obtain IDs for the adults – called sponsors – who take in migrant children. And, for every five cases, HHS didn’t follow up to check on the children it had placed, often for months.
Persons: , Biden, , Haley Lubeck, , Jeff Nesbit, Joe Biden, Organizations: WASHINGTON, of Health, Human Services, HHS Locations: U.S, Mexico
But this sharp increase “likely reflects changes in surveillance methods rather than change in disease risk,” according to the CDC. The vast majority of Lyme disease cases in the US are reported from just over a dozen jurisdictions in the Northeast, mid-Atlantic and upper-Midwest where ticks are particularly prevalent. Despite the significant spike, the number Lyme disease cases that are reported to the CDC is just a fraction of the estimated number of total cases. There are about 476,000 estimated diagnoses of Lyme disease in the US each year – nearly eight times more than even the improved surveillance methods captured in 2022. Lyme disease is the most common vector-borne disease in the US, along with Zika virus, West Nile virus, dengue, malaria, plague, Rocky Mountain spotted fever and alpha-gal syndrome.
Persons: Lyme, , Dr, Sanjay Gupta, Organizations: CNN, US Centers for Disease Control, CDC, of State, Territorial, Get CNN, CNN Health, US Department of Health, Human Services, HHS Locations: United States, Northeast, Lyme
An independent government watchdog found serious lapses at the Department of Health and Human Services in its protection of children who migrate to the United States on their own, according to a report released Thursday. H.H.S., the federal agency responsible for sheltering migrant children when they arrive by themselves, repeatedly handed them over to adult sponsors in the United States without thorough vetting and sometimes failed to conduct timely safety checks on children once they were released, said the report by the department’s inspector general. “I would define these gaps as very serious,” said Haley Lubeck, the project leader for the review. “We know that these children are especially vulnerable to exploitation.”The findings echoed New York Times reporting that the screening of sponsors and other safeguards for migrant children broke down during the first years of the Biden administration as hundreds of thousands of children crossed the border amid a pandemic-era economic collapse in parts of Central America. Migrant children have ended up working dangerous industrial jobs in violation of child labor laws across the country — in slaughterhouses, factories, construction sites and elsewhere, The Times found.
Persons: H.H.S, , , Haley Lubeck, Biden Organizations: Department of Health, Human Services, New York Times, Times Locations: United States, Central America, slaughterhouses
They are group purchasing organizations, which broker drug purchases for hospitals and other health-care providers, and drug wholesalers, which buy medicines from manufacturers and distribute them to providers. But the Biden administration is zeroing in on other players in the drug supply chain to uncover the "root causes and potential solutions" to ongoing shortages. The Federal Trade Commission on Wednesday said it is examining the role that drug wholesalers and companies that purchase medicines for U.S. health-care providers play in shortages of generic drugs, which account for the majority of Americans' prescriptions. Group purchasing organizations and wholesalers have gotten limited attention on Capitol Hill, even as reining in high drug costs has become a key priority among lawmakers in both chambers. PBMs contend that manufacturers are responsible for high drug prices, while drugmakers say rebates and fees collected by those middlemen force them to increase list prices for products.
Persons: Biden, Doug Farrar, Cencora Organizations: FTC, Department of Health, Human Services, Federal Trade Commission, Public Affairs, CNBC, HHS, Cardinal Health, Group, Capitol, CNBC PRO Locations: U.S
Hospitals in recent years have shifted their use of online technology to support everything from telehealth to medical devices to patient records. Brett Callow, an analyst for the cybersecurity firm Emsisoft, counted 46 cyberattacks on hospitals last year, compared with 25 in 2022. The dramatic increase in these online raids has prompted the nation’s top health agency to develop new rules for hospitals to protect themselves from cyber threats. The attacks can put hospitals’ networks offline for weeks or months, forcing hospitals to turn away patients. In Chicago, Lurie hospital’s network has been offline for two weeks.
Persons: , John Riggi, Association’s, , ” Riggi, Ann, Robert H, Lurie, Brett Callow, Emsisoft, ” Callow, Callow, , Andrea Palm, Palm, Jason Castillo’s, Castillo, ” Castillo, it’s, Kathleen Foody Organizations: WASHINGTON, Midwestern children's, American, Lurie Children’s Hospital of Chicago, FBI, of Health, Human Services, Health, HHS, Associated Press Locations: Midwestern, Russia, North Korea, Iran, Chicago
CNN —A single rabid coyote in Rhode Island is believed to have attacked two people in neighboring towns in the span of two days, state environmental officials said this week. The same animal likely attacked another person on Thursday in Scituate, about 11 miles away, officials said in a Monday news release. There has not been a human case of rabies in Rhode Island since 1940. Rabies is endemic in Rhode Island and the state has had terrestrial rabies since 1994. If someone is bitten or scratched by a wild animal, they should contact a health professional right away, the health department said.
Persons: Scott Marshall, Marshall Organizations: CNN, Johnston Police Department, Rhode Island Department of Health, Coyotes Locations: Rhode Island, Belfield, Johnston, Scituate,
The Federal Trade Commission and the Department of Health and Human Services said on Wednesday that they would examine the causes of generic drug shortages and the practices of “powerful middlemen” that are involved in the supply chain. The federal agencies’ inquiry is aimed at the group purchasing organizations and drug distributors that have been in the spotlight in recent months as drug shortages reached a 10-year peak. During Congressional hearings in the last year, oncology experts have testified about the effects of the shortages, describing difficult decisions that forced them to ration key chemotherapy drugs. “For years Americans have faced acute shortages of critical drugs, from chemotherapy to antibiotics, endangering patients,” Lina Khan, the F.T.C. “Our inquiry requests information on the factors driving these shortages and scrutinizes the practices of opaque drug middlemen.”
Persons: ” Lina Khan Organizations: Federal Trade Commission, Department of Health, Human Services
The decision is an early win for the Biden administration as it grapples with a flurry of other legal challenges that drugmakers have filed against the Medicare drug price negotiations. The judge's ruling won't end the legal battle over the policy, which could end up at the Supreme Court. A slate of major companies with drugs selected for negotiations, including J&J, Merck , and Bristol Myers Squibb , have filed separate lawsuits challenging the constitutionality of the price talks. The suit also argued that the price talks violate the Eighth Amendment because they include a "crippling" excise tax aimed at forcing drugmakers to accept the government-dictated price of medicines. The groups also argued that the price talks violate due process by denying pharmaceutical companies and the public input on how Medicare negotiations will be implemented.
Persons: Biden, drugmakers, Judge David Ezra of, Ezra, NICA's, Nicole Longo, PhRMA, Eli Lilly, Johnson, NICA Organizations: U.S . Department of Health, Human Services, Supreme, Medicare, Western, Western District of Texas, Pharmaceutical Research, Manufacturers of America, Global Colon Cancer Association, National, Center Association, CNBC, Pfizer, Johnson, Merck, Bristol Myers Squibb, Chamber of Commerce, Department of Health, Department of Justice Locations: Washington ,, Western District, PhRMA, Ohio
CNN —Health officials in Alaska have identified the first known death linked to a recently discovered virus called Alaskapox. Since its discovery in 2015, seven Alaskapox infections have been reported, according to the state Department of Health. “This is the first case of severe Alaskapox infection resulting in hospitalization and death,” the health department said in a release last week. Still, there is a lot that isn’t known about the virus, McLaughlin said, including how it spreads from animals to humans and how long it has been around. “What has changed is clinician awareness and the general public’s awareness that Alaskapox virus is something that’s a possibility,” McLaughlin said.
Persons: , Joe McLaughlin, McLaughlin, Alaskapox, , ” McLaughlin, Julia Rogers, ” Rogers, Rogers, Dr, Sanjay Gupta Organizations: CNN — Health, of Health, Alaska ., Alaska Department of Health, Epidemic Intelligence, US Centers for Disease Control, Health, The Alaska Department of Health, Get CNN, CNN Health Locations: Alaska, Africa, Asia, Europe, Fairbanks, Kenai
Officials at Lurie Children's Hospital said Thursday that they are still working with the FBI and other law enforcement but told reporters that a “known criminal threat actor” had accessed the hospital's network. The hospital shut down its own systems for phone, email and medical records once the breach was discovered on Jan. 31, officials said. “This is an active and ongoing investigation.”The situation at Lurie Children’s Hospital had all the hallmarks of a ransomware attack, although hospital officials have not confirmed or denied the cause. The latest annual report for Lurie Children’s said staff treated around 260,000 patients last year. Chicago-area pediatrician practices that work with the hospital also have reported being unable to access digital medical records because of the attack.
Persons: , , Marcelo Malakooti, Allan Liska, Lurie, ” Liska, ” Malakooti, Brett Callow, Emsisoft, Lurie Children’s Organizations: CHICAGO, Lurie Children's, FBI, Lurie Children’s Hospital, Associated Press, U.S . Department of Health, Human Services Locations: Chicago
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